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  • 1
    Language: English
    In: General Thoracic and Cardiovascular Surgery, Jan, 2014, Vol.62(1), p.64(4)
    Description: Byline: Mario Lescan (1), Tobias Walker (1), Joseph Kobba (1), Wilke Schneider (1), Christian Schlensak (1) Keywords: Takotsubo cardiomyopathy; Sinus valsalva aneurysm; Preoperative management Abstract: We report a case of a 43-year-old woman, who presented with thoracic interscapular pain at a peripheral hospital. In addition, the patient reported retrosternal pain, which had occurred only hours before--after an upsetting telephone call. The CT imaging ruled out an aortic dissection but revealed a huge sinus valsalva aneurysm (SVA) while the laboratory parameters showed slightly elevated troponin T value. Echocardiography showed an akinesia of the midventricular and apical left ventricular wall, accompanied by normal basal contractility. Stenotic coronary disease and endomyocarditis could be excluded as the origin of the contractility disorders. The synopsis of the findings and patient's medical history led to the assumption of the takotsubo cardiomyopathy triggered by stress due to the worrying telephone call and the pain originating from the symptomatic SVA. We decided to perform an elective operation of the symptomatic aneurysm after restitution of the ejection fraction--as expected in takotsubo cardiomyopathy--instead of an emergency operation. Author Affiliation: (1) Department of Cardiovascular and Thoracic Surgery, University Hospital Tuebingen, Hoppe Seyler Strasse 3, 72076, Tuebingen, Germany Article History: Registration Date: 22/01/2013 Received Date: 15/10/2012 Accepted Date: 21/01/2013 Online Date: 02/02/2013
    Keywords: Troponin ; Myocardial Diseases ; Aneurysm ; Coronary Heart Disease
    ISSN: 1863-6705
    Source: Cengage Learning, Inc.
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  • 2
    Language: English
    In: General Thoracic and Cardiovascular Surgery, 2014, Vol.62(1), pp.64-67
    Description: We report a case of a 43-year-old woman, who presented with thoracic interscapular pain at a peripheral hospital. In addition, the patient reported retrosternal pain, which had occurred only hours before–after an upsetting telephone call. The CT imaging ruled out an aortic dissection but revealed a huge sinus valsalva aneurysm (SVA) while the laboratory parameters showed slightly elevated troponin T value. Echocardiography showed an akinesia of the midventricular and apical left ventricular wall, accompanied by normal basal contractility. Stenotic coronary disease and endomyocarditis could be excluded as the origin of the contractility disorders. The synopsis of the findings and patient’s medical history led to the assumption of the takotsubo cardiomyopathy triggered by stress due to the worrying telephone call and the pain originating from the symptomatic SVA. We decided to perform an elective operation of the symptomatic aneurysm after restitution of the ejection fraction—as expected in takotsubo cardiomyopathy—instead of an emergency operation.
    Keywords: Takotsubo cardiomyopathy ; Sinus valsalva aneurysm ; Preoperative management
    ISSN: 1863-6705
    E-ISSN: 1863-6713
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  • 3
    In: European Journal of Cardio-Thoracic Surgery, 2015, Vol. 48(2), pp.221-227
    Description: OBJECTIVES: To investigate the regional and directional compliance/distensibility of the healthy aorta.METHODS: Complete fresh porcine aortas (n = 11) were perfused ex vivo under defined haemodynamic parameters using a custom-made pulse duplicator. Both circumferential and longitudinal compliance were measured optically.RESULTS: The pulse duplicator was able to perfuse the entire aorta with arbitrary haemodynamic parameters, generating a physiological pulse curve. Aortic compliance is pressure dependent, as we observed a linear relationship between pressure and distension in the range of 5-200 mmHg; however, above 200 mmHg, the porcine aorta behaved in an inelastic manner. Circumferential compliance was highest in the ascending aorta (24%/100 mmHg) but significantly (P 〈 0.05) decreased in both the arch (18%/100 mmHg) and the descending aorta (15%/100 mmHg). Longitudinal compliance was highest in the ascending aorta and clearly exceeded circumferential compliance. Compliance was significantly (P 〈 0.05) higher in the outer curvatures of the ascending aorta and the aortic arch compared with the compliance of the inner curvature at these locations (30%/100 vs 23%/100 mmHg in the ascending aorta and 20%/100 vs 9%/100 mmHg in the arch, respectively).CONCLUSIONS: Longitudinal compliance of the ascending aorta, particularly the outer curvature, is predominantly responsible for the 'Windkessel effect'. Pathological changes such as elongation and pronounced angulation of the ascending aorta increase stress on the outer curvature and may be important factors in the development of aortic dissection.
    Keywords: Aorta ; Aortic Compliance ; Aortic Dissection
    ISSN: 1010-7940
    E-ISSN: 1873-734X
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  • 4
    In: Interactive CardioVascular and Thoracic Surgery, 2016, Vol. 23(1), pp.104-111
    Description: To gain differential knowledge about the physiological compliance and wall strength of the different regions of the aorta, including the ascending aorta, arch and descending aorta in both the circumferential and longitudinal directions, and to generate a hypothesis on the pathophysiological mechanisms that lead to Type A aortic dissection. Fresh tissue specimens from 22 ex vivo porcine aortas were analysed on a tensile tester. Regional and directional compliance, failure stress and failure strain were recorded. Aortic compliance appeared as a linear function of the natural logarithm (ln) of wall stress. Compliance significantly decreased along the length of the aorta. In the ascending aorta, longitudinal compliance significantly (P = 0.003) exceeded circumferential compliance, and the outer curvature was more compliant than the inner curvature (P = 0.03). In the descending aorta, this relationship is reversed: the circumferential compliance exceeded the longitudinal compliance, and the outer aspect was more compliant (P = 0.003). The median circumferential failure stress of all aortic segments was in the range of 2000-2750 kPa, whereas the longitudinal failure stress in the ascending aorta and the arch had values of 750-1000 kPa, which were significantly lower (P 〈 0.05). Surprisingly, the longitudinal failure stress of the inner aspect of the descending aorta was extraordinarily high (2000 kPa). Failure strain, similar to compliance, was highest in the ascending aorta and decreased along the aorta. The aorta appears to be a complex organ with distinct regional and directional differences in compliance and wall strength that is designed to effectively absorb the kinetic energy of cardiac systole and to cushion the momentum of systolic impact. Under normotensive conditions and a preconditioned physiological morphology, the aortic wall works in the steep part of the logarithmic strain-stress function; under hypertensive conditions and pathological morphology, the wall reacts in an non-compliant manner. The high longitudinal compliance and low failure stress of the ascending aorta and subsequent pathological changes may be the main determinants of the recurrent patho-anatomy of Type A aortic dissection.
    Keywords: Aorta ; Aortic Compliance ; Aortic Dissection
    ISSN: 1569-9293
    E-ISSN: 1569-9285
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  • 5
    In: European Journal of Cardio-Thoracic Surgery, 2018, Vol. 54(1), pp.26-33
    Description: OBJECTIVES: To study the lengths and diameters of aortic segments in healthy and diseased aortas and to assess the role of aortic elongation in Type A aortic dissection (TAD) prediction.METHODS: Ectasia and aneurysm were defined by ascending aorta diameters of 45-54 mm and ≥55 mm, respectively. Computed tomography angiography studies of 256 healthy, 102 ectasia, 38 aneurysm, 17 pre-TAD and 166 TAD aortas were analysed using curved multiplanar reformats.RESULTS: The study groups were structurally equal. The diameter of the ascending aorta was 35 mm in the control group and was larger (P 〈 0.001) in the pre-TAD (43 mm) and TAD (56 mm) groups. The length of the ascending aorta from the aortic annulus to the brachiocephalic trunk was 92 mm in the control group, 113 mm in the ectasia group, 120 mm in the aneurysm group and 111 mm and 118 mm in the pre-TAD and TAD groups (all P 〈 0.001 compared with the control group). An ascending aorta length of 120 mm was exceeded in 2% of the control group, 31% of the ectasia group, 50% of the aneurysm group, 24% of the pre-TAD group and 48% of the TAD group. The correlation between the diameter and the length of the ascending aorta was r = 0.752; therefore, both parameters must be examined separately. A score considering both parameters identified 23.5% of pre-TAD patients, significantly more than the diameter alone, and 31.4% of ectasia aortas were elongated.CONCLUSIONS: Patients with ectatic (45-54 mm diameter) and elongated (≥120 mm) ascending aortas represent a high-risk subpopulation for TAD.
    Keywords: Aorta ; Aortic Dissection ; Aortic Aneurysm
    ISSN: 1010-7940
    E-ISSN: 1873-734X
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  • 6
    In: European Journal of Cardio-Thoracic Surgery, 2016, Vol. 50(2), pp.241-247
    Description: OBJECTIVES: Unlike aneurysm formation, the role of ascending aortic elongation in the pathogenesis of Type A aortic dissection (TAD) is largely unclear. We investigated the morphology of healthy, dissected and predissection aortas with a focus on ascending aortic length.METHODS: We retrospectively compared clinical and computer tomography angiography (CTA) data from TAD patients (n = 130), patients who developed a TAD in the further clinical course (preTAD, n = 16) and healthy control patients who received a CTA for non-aortic emergencies (n = 165). The length of the ascending aorta was defined as the distance between the sinotubular junction (STJ) and the brachiocephalic trunk (BCT) at the central line, the outer and inner curvature as well as the direct distance in the frontal and sagittal planes. Additionally, the aortic diameters were analysed.RESULTS: In the healthy controls, we found a positive correlation of age with the aortic diameter (r = 0.57) and aortic length (r = 0.42). The correlation of the respective parameters with the body size was negligible (r 〈 0.2). The median ascending aortic diameter at the height of the pulmonary artery in TAD (50 mm) was significantly (P 〈 0.001) larger compared with the respective diameter of the healthy aortas (34 mm). The diameter of the preTAD aortas (40 mm) was also significantly larger compared with the healthy controls. These proportions were similar in all the aortic diameters. The midline length of the healthy ascending aortas was 71 mm. In the preTAD and TAD aortas, the same values were 81 mm and 92 mm, respectively (both P 〈 0.001). We evaluated the linear distance between the STJ and the BCT in the frontal plane as an easy-to-measure parameter of aortic length. In the TAD aortas (108 mm) and preTAD aortas (97 mm), this distance was significantly longer compared with the healthy aortas (84 mm).CONCLUSIONS: Aortic diameter might not be an optimal parameter to predict dissection. Most aortas dissect at diameters below 55 mm. Both the TAD and preTAD aortas were elongated compared with the healthy controls. Thus, aortic elongation may play a role in the pathogenesis of and may be a risk factor for TAD.
    Keywords: Aorta ; Aneurysm ; Aortic Elongation ; Aortic Dissection ; Computed Tomography
    ISSN: 1010-7940
    E-ISSN: 1873-734X
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  • 7
  • 8
    Language: German
    In: Deutsche medizinische Wochenschrift (1946), March 2010, Vol.135(9), pp.394
    Description: We report on a patient with known hypertension, who presented to his general practitioner with severe thoracic pain of sudden onset. The aches had started during a dental treatment. Immediately, the patient was admitted to hospital by the general practitioner because myocardial ischemia was suspected. Neither the electrocardiogram nor the laboratory findings (creatin kinase, troponin I) argued for an acute coronary syndrome. Since the plasma D-dimer level was increased and the transthoracic echocardiography showed discrete signs of right ventricular strain, pulmonary embolism could not be ruled out. Because of the high intensity of pain and for further diagnostics the patient underwent a contrast medium-enhanced computed tomography (CT). The contrast medium-enhanced CT showed a type B acute aortic dissection. According to the current guidelines for the treatment of type B aortic dissection, a conservative therapeutic regimen was applied. Antihypertensive therapy was escalated. Furthermore, the patient transiently received analgesic drugs. After three weeks the patient was released from hospital without pain and with physiologic blood pressure under intensified antihypertensive therapy. A follow up examination three months after the acute aortic dissection showed a constant aortic diameter. Therefore, surgical treatment was not indicated. This case report illustrates a typical clinical picture of acute aortic dissection and gives an overview about its epidemiology, classification, pathogenesis, and prognosis. Furthermore, the diagnostic opportunities and the current guidelines for the treatment of acute aortic dissection are discussed.
    Keywords: Dental Care ; Emergencies ; Acute Coronary Syndrome -- Diagnosis ; Aneurysm, Dissecting -- Diagnosis ; Aortic Aneurysm, Thoracic -- Diagnosis ; Chest Pain -- Etiology
    ISSN: 00120472
    E-ISSN: 1439-4413
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  • 9
    Language: English
    In: Journal of Shellfish Research, 2013, Vol.32(3), p.779(5)
    Description: In Newfoundland, the American lobster (Homarus americanus) fishery has considerable socioeconomic value. Concern about the sustainability of this fishery continues to be a concern as a result of high exploitation rates. Conservation initiatives (marine protected areas, a slot fishery, and v-notching) have been established in several lobster fishing areas (LFAs) in western Newfoundland to increase the number of large lobsters and fecundity (egg production) of populations. However, there has been concern by harvesters in western Newfoundland, where slot fisheries are in effect, that the large lobsters being caught are rarely ovigerous. We used extensive field data from 5 LFAs in western Newfoundland (LFA12, LFA13A, LFA13B, LFA14A, and LFA14B) to test whether the spawning odds depend on size in a slot fishery, where large females were present in sufficient numbers to allow reliable estimates. Three analyses of size-dependent spawning odds were conducted via logistic regression: 2 analyses by year for LFA14A and LFA14B from 2006 to 2011 and 1 spatial analysis for 5 LFAs (LFA12, 13A, 13B, 14A, and 14B) during the same year (2010). In 4 of 6 y, for both LFA14A and LFA14B, spawning odds increased with size, and for 3 of the 5 LFAs for the same year, spawning odds increased with size. We found no evidence of a decrease in spawning odds with size and, equivalently, no decrease in percent ovigerous with increasing size. Our results support the use of spawning odds to calculate the effects of sustainability measures in lobsters.
    Keywords: American Lobster – Environmental Aspects ; American Lobster – Growth ; Animal Populations – Environmental Aspects ; Animal Populations – Growth ; Animal Reproduction – Research
    ISSN: 0730-8000
    E-ISSN: 19436319
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  • 10
    Language: German
    In: Herz, 2013, Vol.38(5), pp.490-500
    Description: In diesem Artikel geben wir einen Überblick über bisher verfügbare Techniken zur perkutanen Mitralklappenanuloraphie über den Koronarsinus bei Patienten mit funktioneller Mitralklappeninsuffizienz. Die größte klinische Erfahrung besteht für das Carillon™ Mitral Contour System™, das in den letzten beiden Jahren auch außerhalb von Studien eine zunehmende Anwendung gefunden hat. Es zeichnet sich durch eine relativ einfache Anwendung und eine effiziente Reduktion der funktionellen Mitralklappeninsuffizienz mit konsekutiver Verbesserung der echokardiographischen und klinischen Parameter aus. Limitierend sind Kompromittierungen des Koronarflusses vor allem bei Kreuzen des Koronarsinus mit dem Ramus circumflexus. Zukünftige Untersuchungen müssen den Stellenwert dieser Technologie im Vergleich zum Mitralklappen-Clipping in der Therapie der funktionellen Mitralklappeninsuffizenz untersuchen. In this article we review the currently available data on percutaneous mitral valve annulorrhaphy devices using the coronary sinus in patients with functional mitral valve regurgitation (MR). Of these devices the greatest clinical experience exists for the Carillon mitral contour system which has gained increasing application also outside trials in the last 2 years. The advantages include the ease of use with an effective reduction in functional MR and a subsequent improvement of echocardiographic and clinical parameters. A limitation is the compromise of flow in the circumflex artery in some patients especially with a crossing of the coronary sinus with this artery. Future investigations need to focus on the evaluation of this coronary sinus-based technology versus mitral valve clipping technology for the treatment of functional MR.
    Keywords: Functional mitral valve insufficiency ; Mitral valve annulorrhaphy ; Coronary sinus ; Carillon™ mitral contour system™ ; Mital valve clipping
    ISSN: 0340-9937
    E-ISSN: 1615-6692
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